Pill may be as effective as surgery for diabetes, obesity

Studies with rats suggest the pill has the same effect on the body as gastric bypass, but could render the surgical procedure unnecessary for some patients.

By

Allen Cone

This is an illustration of "surgery in a pill" in the intestine to reverse obesity and type 2 diabetes. Image by Randal McKenzie/Brigham and Women's Hospital

June 12 (UPI) -- Rather than invasive weight loss procedures, a "surgery in a pill" has shown promise for treatment of type 2 diabetes in obese patients, according to a study.

Researchers at Brigham and Women's Hospital in Boston conducted a preclinical study with rats in which an oral agent would allow food to pass through without being fully absorbed into the body. Their findings were published Monday in the journal Nature Materials.

Bariatric surgery -- in which the stomach is reduced to the size of an egg, and the lower part of the intestine is brought up to meet the stomach -- is effective at reversing obesity but the procedure is expensive and there are risks.

"What we've developed here is essentially, 'surgery in a pill,'" co-lead author Dr. Yuhan Lee, a materials scientist in the BWH Division of Engineering in Medicine, said in a press release. "We've used a bioengineering approach to formulate a pill that has good adhesion properties and can attach nicely to the gut in a preclinical model. And after a couple of hours, its effects dissipate."

Researchers found the substance could temporarily coat the intestine to prevent nutrients from reaching the lining of the proximal bowel, as well as prevent increases in blood sugar, which is linked to diabetes.

The researchers searched for a substance that can stick to the small intestine and then dissolve within a few hours.

Ultimately, they selected sucralfate, which is already approved by the U.S. Food and Drug Administration for treatment of gastrointestinal ulcers.

Then they engineered the substance into a material that can coat the lining of the intestine without requiring activation by gastric acid. The engineered compound -- Luminal Coating of the Intestine, or LuCi -- can be formulated as a dry powder, to be placed in a pill.

Blood sugar levels generally rise and stay elevated after a meal, but one hour after LuCI was administered to rats in the study, glucose was lowered by 47 percent. Three hours later, the effect essentially disappeared.

"We envision a pill that a patient can take before a meal that transiently coats the gut to replicate the effects of surgery," co-senior author Dr. Jeff Karp, a bioengineer and principal investigator at BWH, said. "Over the last several years, we've been working with our surgical colleagues on this idea and have developed a material that meets an important clinical need."

Researchers are now testing LuCl in diabetic and obese rodents, measuring it's short- and long-term effects as an alternative to gastric bypass.

There were 216,000 bariatric surgeries performed in the United States in 2016, according to the American Society for Metabolic and Bariatric Surgery, and the surgery is effective -- but researches think having a pill with similar effects could be a good tool available for patients.

"Gastric bypass is one of the best studied surgeries in the world, and we know that it can lead to many benefits including positive effects for blood pressure, sleep apnea and certain forms of cancer, and a remarkably fast and weight-independent improvement in diabetes," said Dr. Ali Tavakkoli, co-director of the Center for Weight Management and Metabolic Surgery at BWH. "Having a transient coating that could mimic the effects of surgery would be a tremendous asset for patients and their care providers."